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BOND DRUG COMPANY OF ILLINOIS, L.L.C.
DSH140209 METHODIST MEDICAL CENTER OF ILLINOIS
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Covered Entity Details
Entity Name
METHODIST MEDICAL CENTER OF ILLINOIS
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH140209
Entity Address
221 NE GLEN OAK AVE.
PEORIA, IL 61636
Medicare Provider Number
140209
Participating Start Date
10/1/2006
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
BOND DRUG COMPANY OF ILLINOIS, L.L.C.
Pharmacy Address
DBA: WALGREENS # 04732
2020 COURT STREET
PEKIN, IL 61554
Pharmacy Comments
Contract Details
Approval Date
10/26/2012
Contract Begin Date
10/26/2012
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
DEBORAH R. SIMON, PRESIDENT AND CEO
(309) 672-5929
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/12/2012
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